On the new HHS chief, Affordable Care Act and Medicaid work rules

While commercial health care insurance companies try to figure out what to do with the new Amazon/Berkshire-Hathaway/JP Morgan partnership aimed at building a new employee health plan, we saw some national health care issues unfold toward the end of 2017 and the first month of the new year.

Alex Azar, a former Eli Lily executive, was confirmed as the new HHS Secretary. It is the second stint for Azar in the White House, having served as deputy secretary under President George W. Bush.

While President Trump’s plan to repeal and replace the Affordable Care Act did not occur, the individual mandate to have health insurance is no longer in force. It was eliminated as part of the tax legislation passed in December 2017. Employers with 50 or more full-time employees are still required to provide insurance to their employees and their dependents or be subject to a penalty.

The 12-week window for open enrollment for ACA exchange health plans decreased from 12 weeks to 6 weeks, which caused some worry that people who thought they could enroll until the end of the year would miss their enrollment opportunity. Some states that operate their own health insurance marketplaces extended the enrollment deadline past the federal requirement.

Subsidies still available

Individuals making less than $48,240 or $98,400 for a family of four still receive subsidies from the federal government to help pay health care premiums. However, the federal subsidies that insurers received were discontinued, causing some increases in premiums for those not qualifying for subsidies to make up for the loss. With more than half of the counties in the United States having just one carrier, competition for affordable plans was a concern. The average premium increase in the United States was 37%; however, premium increases varied widely by state. Alaskans saw a decrease of 22% in the state’s benchmark silver plan due to the reinsurance program started there last year. The program provides payments to Premera, the lone insurer on the state’s marketplace, for insuring people with high cost medical conditions. Conversely, in Iowa, the one carrier operating in the state increased the premiums in the benchmark silver plan by 88%. There are also new, expanded bronze plans that the Trump Administration requires insurers to carry. These plans have lower premiums but higher out-of-pocket costs. The states that offer plans via the federal marketplace also allow individuals to purchase a bronze high-deductible plan with a health savings account.

Future legislation may provide vehicles to dismantle parts of the ACA or, at a minimum, shore up the insurance industry. Rep. Paul Ryan, R-Wis., has suggested there may be bipartisan legislation that would focus on sending money back to states to establish high-risk pools or reinsurance programs which are designed to cushion the insurance market for costs associated with covering high-cost individuals. With the new HHS Secretary in place, anything is possible.

For additional reading:

Adamczyk A, et al. Panicking about Trump’s changes to Obamacare? Here’s what you need to know. TIME. Available at: www.time.com/money/4981358/panicking-about-trumps-changes-to-obamacare-heres-what-you-need-to-know/. Accessed: Feb. 6, 2018.

DeLoatch P. ACA compliance in 2018: What’s changing and what’s staying the same. HRDive. Available at: www.hrdive.com/news/aca-compliance-in-2018-whats-changing-and-whats-staying-the-same/511984/. Accessed: Feb. 6, 2018.

Hellman J. Ryan suggests room for bipartisanship on Obamacare. The Hill. Available at: http://thehill.com/policy/healthcare/368762-ryan-suggests-room-for-bipartisanship-on-obamacare. Accessed: Feb. 6, 2018.

Luhby T. Five changes for Obamcare open enrollment for 2018. Money. Available at: http://money.cnn.com/2017/11/01/news/economy/obamacare-open-enrollment-2018/index.html. Accessed: Feb. 6, 2018.

Pear R. Individual mandate now gone, G.O.P. targets the one for employers. The New York Times. Available at: www.nytimes.com/2018/01/14/us/politics/employer-mandate.html. Accessed: Feb. 6, 2018.

Leonard K. After failing to undo the law, Trump administration rolls out Obamacare 2018. Washington Examiner. Available at: www.washingtonexaminer.com/after-failing-to-undo-the-law-trump-administration-rolls-out-obamacare-2018/article/2638571. Accessed: Feb. 6, 2018.

For more information: Wendy Funk Schrag, LMSW, ACSW, is the vice president of state government affairs for Fresenius Medical Care North America and is based in Newton, Kansas. She is also a member of NN&I’s Editorial Advisory Board. Disclosure: Funk Schrag reports no relevant disclosures.